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Business Owners Questionnaire - ALTN

Name Insured:

First Name Last Name

Street Address:

Street Address Address Line 2 City State/Prov./Region ZIP/Postal

Phone Number

Cell Number

Name

First Name Last Name

Landlord Name and Address:

Fax:

Description of Business

Years in Business:

Number of Employees:

Tax ID Number:

Medical Director:

Loss Information:

Gross Sales:

Payroll:

Property Information

Building

Number of Stories:

Square Feet:

Construction type:

Year Built:

Building Updates

Roof:

Plumbing:

Electric:

Heating:

Alarm:

Other occupants in building:

Building/Additions & Alterations Limit: (cost of buildout)

Deductible:

Content Limit:

Deductible:

If new, Effective Date of opening:

Additional Information:

Please do not include sensitive, private information in this area.

Additional Attachments: (landlord requirements)

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Max. file size: 300 MB.

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1720 Harrison Street, Suite 6-A
Hollywood, FL 33020

954-456-7505
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954-458-6520 fax

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Experience the Value of an Independent Agency

Marker Insurance is committed to serving the insurance needs of individuals, families, and businesses throughout Florida. Our goal is to deliver quality coverage options that align with our clients’ values and goals, fostering long-term relationships built on trust and reliability.

We are licensed in FL, TX, PA, NJ, and GA.